Editor s Note:Click here to read a December 2008 JEMS article on stroke centersand the 2005 JEMS article Time Is Brain, a comprehensive article about prehospital management of stroke patients.
Ida Comparin did everything right on Aug. 12, 1996.
When her husband, Bob, arose that summer morning with numbness in his left arm and leg, she wasted no time.
"I came right in here and called 911," the former librarian said. "I don't know how I knew, but I'm very good in emergencies."
Bob Comparin -- who was 68 at the time and was enjoying life after retiring from his position as head of Virginia Tech's mechanical engineering department -- had suffered a stroke.
"I was having a good time and then wham! I'm lying there in the hospital watching those damned doves flying around," Bob Comparin recalled.
"He's a hunter," his wife explained. Ida Comparin feared her husband's stroke would have a severe psychological effect on such an active outdoorsman.
The couple, both now 80 and married more than 50 years, have since learned that a stroke can be debilitating, humiliating and frustrating.
But it can also be survived.
A blood clot in the right side of his brain left Comparin's left arm and leg partially paralyzed.
"His left side was paralyzed pretty bad," his wife noted. "He was depressed when it first happened, but he bounced back. He has a very positive attitude. He always says I worry enough for both of us."
Bob Comparin still goes hunting with his buddy, Bob Ellis. He works out at the Weight Club three times a week. He does the grocery shopping. He drives.
He does that all with the help of a brace that he wears on his left leg and special equipment installed in his Ford Escape. He has a La-Z-Boy lift chair in the living room of his Blacksburg home and a book stand that he uses for reading. He has trouble holding a book and turning the pages.
Because he also has trouble tying shoe laces, Bob Comparin put his engineering expertise to good use and designed Velcro attachments for his hunting boots.
"I do not have to help him do anything," Ida Comparin said, adding her advice to others who suspect they might be having a stroke:
"Get to the hospital immediately. If they had known then what they know now, I don't think Bob would be in this shape today."
Tissue plasminogen activator -- or tPa -- is a powerful clot-busting drug that was approved by the U.S. Food and Drug Administration more than a decade ago. To be effective on the most common type of strokes caused by blockage of an artery to the brain, the drug needs to be administered within three hours of the onset of stroke symptoms. Imaging tests have to be done to identify the cause.
That means that stroke victims must be treated quickly.
And to receive treatment in a timely manner, they have to recognize the problem and ask for help.
"The problem we have is that people don't have any idea what the signs of a stroke are and they don't have any idea how important it is to get help quickly," said Susan Bricken of the Christiansburg Rescue Squad. "We pick up people constantly with stroke symptoms. There's a three-hour window for definitive treatment. Three hours.
"It's the one thing for which I'll drive lights and sirens as fast as I can," Bricken added.
No tardy excuses
Scott Pritchard, the Christiansburg Rescue Squad's training officer, urges people to be aware of stroke symptoms.
"Any sort of altered mental status -- slurred speech, acting intoxicated. They may try to pour a glass of water into a plate instead of a glass," he said in describing people he has treated with stroke symptoms. Facial weakening or any kind of sudden neurological changes also are indicators.
"TIAs -- also called mini-strokes -- can be a warning sign," Pritchard said. "Even if you have these symptoms and they're resolved after a few minutes, it's still important to be seen at the emergency room."
Stokes, Pritchard said , are caused by oxygen deprivation to the brain.
"Oxygen gets there through the blood," he said. "There's a window of time that the brain can do reasonably well without oxygen. If you wait too long, the deficits are irreversible."
Pritchard, Bricken and other rescue volunteers have many horror stories about patients they could have helped if they had been called earlier.
"I think the saddest stroke person I had as a man who had moved here and didn't know anyone. He woke up with stroke symptoms and decided he would go back to bed because he thought they would go away."
The man suffered a debilitating stroke.
"I was heartbroken," Bricken said. "I wanted to weep. It's this denial thing. People are scared. They don't want to admit something is wrong. Denial is a very powerful thing."
"Don't be lulled into a false sense of security because it can happen to anybody," Pritchard said.
"It's not just old people," said Bricken. "I had a 24-year-old with a stroke. We had a guy whose wife was having stroke symptoms. He drove her back from Virginia Beach before getting help."
EMT Kevin Hamm likes to point to the success stories that result from quick action.
"We had a guy who walked out of the rec center and lost total control of one side of his body. We called the hospital and told them to activate their stroke team."
Hamm laughed, noting that Montgomery Regional Hospital does not have a stroke team.
"I was hoping they would get the hint," he said.
They did. Emergency room personnel were ready when the patient arrived. Rescue workers bypassed the ER and took the patient directly to radiology for a CT scan.
"That's why the EMS factor is big in strokes," Hamm said.
Denise Haun, a registered nurse who has worked in the emergency room at New River Valley Medical Center for the past 10 years, estimates that she sees 15 to 20 stroke patients each month.
"You see several debilitating strokes," she said, noting that patients are often hesitant to seek help. "They think the symptoms will go away. If they wait too long, we may not be able to help them."
"Strokes are very serious," Haun said. "The longer you wait, the more debilitating the outcome. If you have any symptoms -- blurred vision, severe headache, numbness and tingling of your arms -- don't wait. Go and have it checked out."
A close call
Eddie Trump is 54 and is a member of the Christiansburg Rescue Squad's extolled "Gray Team," a cadre of longtime rescuers. He has volunteered there for 34 years.
He couldn't believe it when doctors told him he suffered a stroke in January.
Trump, who has high blood pressure and diabetes, was just doing his job at Horne Funeral Service when he noticed that his head "felt sort of funny, like a headache."
"For a few days," he recalled, "I had some slurred speech. I couldn't type. I couldn't write my name. I didn't know what to think. I didn't really notice it that bad."
Fellow employees Craig Helvey and Jerry Trump, also his brother, did notice. Both are volunteers with medical knowledge.
"They called my wife," Eddie Trump said. "They said, 'There's something wrong with Eddie. He's repeating things over and over.' I guess they saw more than I did."
Trump was admitted to the hospital. His doctor, Michael Payne, told him his blood pressure was completely out of control.
"They thought it was blood pressure-related," Trump said of his symptoms.
Two weeks later when he was getting a haircut, Trump suddenly felt dizzy. He drove himself to Payne's office where he collapsed at the receptionist's station.
"The last thing I remember was the lady opening the window glass," he said.
After ruling out diabetic-related causes for his collapse, more tests revealed Trump's stroke.
"The neurologist told me the pumps and the pipes were clean," he said. "It was all in my head. I'm on blood thinners now."
Trump's brain attack has not left him with noticeable disabilities. He's now able to type and write his name. To the outside world, he appears totally normal.
But he said he can tell a difference in himself.
"My motions are real sensitive now. I have trouble remembering things," he said. "But I know a lot of people who are so much worse off. I feel almost a guilt complex even talking about it."
Trump said since his stroke, he is trying to get more rest and is keeping a close eye on his blood pressure. In addition to the medication he takes, his doctor has prescribed what doctors prescribe for all of us: more exercise, less stress, healthy diet.
"Listen to your doctors," he advised. "Watch for the signs and symptoms. Do what they tell you."
"All these years on the crew," he added, acknowledging his medical familiarity with stroke symptoms and his sense of humility at being a victim.
"It snuck up on me, too."
Every three minutes, someone dies of a stroke.
Stroke is the third leading cause of death for Americans and the leading cause of long-term serious disability.
About 700,000 Americans have strokes annually.
More than 4 million Americans are stroke survivors: 2.1 million men and 2.2 million women.
Timely treatment of stroke symptoms can make a huge difference in recovery. A recent study showed that those treated within 180 minutes have a 30 percent better outcome at 90 days.
Patients are the key to stroke outcome. If they don't get to the hospital fast enough, they can't be treated effectively.
SOURCES: American Heart Association, American Stroke Association, Inova Health Systems
"My Stroke of Insight" by Dr. Jill Bolte Taylor
Taylor, a professor of neurologic anatomy at Harvard University, suffered a stroke at age 37. After eight years in the recovery process, she wrote about her experience. Among her insights: "When I am simply grateful, life is simply great," and "Internal verbal abuse is not acceptable behavior."
What is a stroke?
A stroke is a brain attack. It happens when a blood clot blocks an artery or a blood vessel breaks and interrupts the flow of blood to the brain. When either of these things happen, cells begin to die from lack of oxygen and brain damage occurs.
Fatty deposits in the lining of the blood vessel wall can lead to an ischemic stroke, one caused by blockage. This accounts for about 87 percent of all strokes.
A hemorrhagic stroke happens when a weakened vessel ruptures and leaks blood into the brain. While only 13 percent of all strokes are hemorrhagic, they are responsible for more than 30 percent of all stroke deaths.
Two million brain cells die every minute during stroke - which is why fast treatment is essential.
SOURCE: National Stroke Association
Stroke risk factors and prevention
Anyone can have a stroke, but several risk factors increase the likelihood.
Being older than 55, being from certain racial backgrounds (particularly African-American, Hispanic or Asian-Pacific Islander) or having a family history of strokes are uncontrollable risk factors. Men are also at a slightly higher risk than women.
Other risk factors, such as smoking cigarettes, are controllable.
If you smoke, quit. If you use alcohol, cut back. A recent study showed that drinking more than two alcoholic drinks a day increased stroke risk by 50 percent.
Prevention is still the best medicine. Transient ischemic attacks (TIAs) are small strokes that last only a few minutes or hours. They should never be ignored and can be treated with drugs or surgery.
Diabetes, heart disease, high cholesterol and high blood pressure are all conditions linked to stroke. It is important to treat and control the conditions. Eat a balanced diet, maintain weight control and exercise to reduce blood pressure. A reading below 120/80 is considered normal.
Atrial fibrillation (irregular heartbeat caused by rapid and unpredictable beating of the two upper chambers of the heart) increases stroke risk up to six times because it allows blood to pool in the heart. When blood pools, it tend to form clots that can then be carried to the brain.
Drug abuse (especially cocaine), low estrogen and inactivity are controllable lifestyle risk factors, as well.
Work with your physician to manage your health issues.
SOURCES: National Institute of Neurological Disorders and Stroke and National Stroke Association